Sudden paraplegia following epidural lipomatosis and thoracal compression fracture after long-term steroid therapy: a case report

Abstract

Sudden paraplegia secondary to the posterior spinal epidural compression and vertebral compression fracture as a complication in corticosteroid treatment is extremely rare. The authors presented a case 49-year-old man with chronic relapsing attack of Still's disease. After the identification of pathology, the surgical evacuation of lipid tissue and pedicle-based instrumentation showed therapeutic success. To the authors' knowledge, this is the first case showing both vertebral fracture and paraplegia that required urgent surgery in the follow-up Still's disease.

Occurrence of sudden paraplegia during follow-up period of thoracic vertebral compression fracture in a case with spinal epidural lipomatosis

“…Two cases of idiopathic SEL [2,3] and one case complicated by epidural abscess [4] have previously been reported. One other case of simultaneous sudden paraplegia and vertebral compression fracture due to SEL, similar to our case, has also been reported [5]. However, in our case, paraplegia emerged 2 months after the fracture, and no worsening of the vertebral fracture was observed on CT at the time of neurological deterioration.…”

Spinal Epidural Lipomatosis: A Review of Pathogenesis, Characteristics, Clinical Presentation, and Management

“…Steroid-induced SEL (both exogenous and endogenous) has been reported to cause spinal cord compression in SEL patients, including acute-onset paraplegia. 38 -41 Most cases occurred following an acute thoracic compression fracture due to osteoporosis in the setting of long-term exposure to steroids, and required urgent surgical decompression. 38 -41 In light of these findings, it may be prudent to monitor bone density in patients being treated for SEL, as compression fractures in the setting of excess epidural fat may have significantly increased morbidity.…”

Subacute steroid-induced paraparesis: surgical treatment of a devastating “invisible” side effect

“…Treatment depends on the severity and acuteness of the onset of symptoms [14]. To avoid prolonged or even irreversible neurological deficits, urgent decompression of the spinal cord is indicated [1,4,20]. The importance of surgical decompression is underlined by the fact that several chronic conditions necessitate steroid intake and make withdrawal or reduction of the steroids impossible.…”

“…In case of moderate to severe osteoporosis as described in case 2 more extensive surgery may be required [4]. Emergency decompression of the spine by laminectomy for removal of the compressive fat tissue may be followed by secondary fusion.…”